Snowmobile Club
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Print this page, fill out and mail to: Harrison Friendly Riders PO Box 817 Harrison, ME 04040 www.HarrisonFriendlyRiders.net |
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HFRSC
Membership
Includes MSA Membership Single $25.00 Family $35.00 Club Membership includes one life ins. policy |
Membership (S)
or (F): $________________ Additional Donation: ___________________ Family Members Insurance: ______________ Total Enclosed: $_______________________ |
Please fill in the following information
Name:
__________________________________________ Date of birth_______________
Address: __________________________________________________________________
City:__________________________________ State: _________ Zip: _______________
Telephone: ______________________ Email: ___________________________________
Beneficiary for MSA Insurance: _______________________ No. of Family
Members_______
Club membership includes one life inusrance policy. Additional Dependant
Life Insurance available for $2.00 per
person for $2000.00 of coverage. Please add family members, DOB &
Beneficiary optional ($2.00/each) for
insurance below. If additional space is needed use back of form.
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________